Treatment of skin diseases

Millions of people over the world suffer from skin disorders such as Psoriasis and Vitiligo. These disorders have a huge impact on the patients’ daily lives. However today, these skin diseases can be treated. Phototherapy is an effective and proven method of treatment. Philips Phototherapy lamps have been developed and tested in close cooperation with universities and clinics around the world.

FDA has cleared Philips Narrowband phototherapy lamps for the treatment of Psoriasis and Vitiligo and has cleared Philips Broadband phototherapy lamps for the treatment of Psoriasis.

Effective treatment ofPsoriasis

If you have Psoriasis, certain parts of your body are overactive in producing new skin cells. Sometimes it affects only small areas and sometimes large parts of the body. Psoriasis affects nearly three percent of the world's population and has a huge impact on these people’s lives.

Diagnosis of Psoriasis

Psoriasis is usually diagnosed just by looking at the affected areas of the body, although some clinics also take skin samples to rule out any other diagnosis.

It is important to talk to your doctor about any form of psoriasis for referral to an appropriate specialist.

PUVA phototherapy

A new era in therapeutic photomedicine was initiated at the start of the 1970’s when, on the basis of research work carried out in USA and Austria, Parrish et al. described the systemic treatment of psoriasis by psoralens and irradiation with UVA, so-called PUVA therapy. At this time the concept of photochemotherapy was introduced. In photochemotherapy, the combination of a photosensitizing chemical compound and optical radiation is used to bring about a therapeutically beneficial result not produced by either the radiation or a drug alone. The drug may be applied topically or orally to reach the skin by blood circulation and is subsequently activated by irradiation with UVA.

Broadband UVB/Narrowband UVB phototherapy

UVB Phototherapy is a type of therapy without any photo-sensitizing agent. It is the oldest form of treatment, and it is based on the experience with the favorable effects of sunlight on the general appearance of the skin. Numerous investigations show that phototherapy with UVB is just as effective as PUVA therapy if the right doses are maintained. Another critical parameter is the UVB wavelength applied. Various investigations imply that the most favorable range for the effective UVB treatment of psoriasis is in the long-wave part of the UVB spectrum (between 305 and 315nm). This warrants a high (therapeutical) efficiency on the one hand and minimum (acute and chronic) risks on the other.

There are mainly two types of fluorescent lamps of different spectral distribution – the TL/01-UVB Narrowband and the TL/12 UVB broadband lamp - available for the therapy of psoriasis. The erythemal effect of the radiation from the TL/01 lamp is much smaller than from the TL/12 lamp so that- with the aim of being able to irradiate as much UVB as possible without producing erythema (reddening of the skin) - the TL/01 is a better proposition. Moreover, recent investigations show that for successful therapy, TL/01 radiation can be dosed far below the erythemal threshold. This makes the period of exposure shorter, reducing overall dosages and thus any acute or chronic side-effects. TL/01 lamps have been tested world-wide in extensive clinical tests and are universally in practice. Balneo-phototherapy, the positive experience with the treatment of psoriatics at the Dead Sea,is being increasingly transferred to the clinic. Brine baths, with a simultaneous or subsequent exposure to UVB (using TL/01) provide better results at a generally lower dosage than in UVB phototherapy. This is mainly attributed to the greater transparency of wet skin. Balneo-phototherapy of psoriasis is successfully applied for in-patients in numerous spas; it is also applied for outpatients in therapeutic centers.

The following links may provide further helpful sources of information.

FDA has cleared Philips Narrowband phototherapy lamps for the treatment of Psoriasis and Vitiligo and has cleared Philips Broadband phototherapy lamps for the treatment of Psoriasis.

Effective treatment ofVitiligo

Unlike Psoriasis, the possibilities for treating vitiligo are limited to phototherapy, except for a small number of patients with stable vitiligo, who can be treated with skin autologous pigment grafts.

The first report of the use of ""phototherapy"" in the treatment of skin disorders dates from about 1400 BC among Hindus, as already mentioned. They used ""photochemotherapy""-administration of plant extracts, followed by sun exposure-for vitiligo. The same treatment was also used in ancient Egypt. The active ingredients in these plant extracts were isolated in 1947 by Fahmy et al. as 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (MOP). In the same year, these authors and also El Mofty started to treat patients with vitiligo with 8-MOP and sun exposure.

Kromayer, a German dermatologist, designed in 1904 a water cooled mercury vapor UV lamp. He was the first to treat vitiligo with artificial UVB.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

FDA has cleared Philips Narrowband phototherapy lamps for the treatment of Psoriasis and Vitiligo and has cleared Philips Broadband phototherapy lamps for the treatment of Psoriasis.

Unlike Psoriasis, the possibilities for treating vitiligo are limited to phototherapy, except for a small number of patients with stable vitiligo, who can be treated with skin autologous pigment grafts.

The first report of the use of ""phototherapy"" in the treatment of skin disorders dates from about 1400 BC among Hindus, as already mentioned. They used ""photochemotherapy""-administration of plant extracts, followed by sun exposure-for vitiligo. The same treatment was also used in ancient Egypt. The active ingredients in these plant extracts were isolated in 1947 by Fahmy et al. as 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (MOP). In the same year, these authors and also El Mofty started to treat patients with vitiligo with 8-MOP and sun exposure.

Kromayer, a German dermatologist, designed in 1904 a water cooled mercury vapor UV lamp. He was the first to treat vitiligo with artificial UVB.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

Unlike Psoriasis, the possibilities for treating vitiligo are limited to phototherapy, except for a small number of patients with stable vitiligo, who can be treated with skin autologous pigment grafts.

The first report of the use of ""phototherapy"" in the treatment of skin disorders dates from about 1400 BC among Hindus, as already mentioned. They used ""photochemotherapy""-administration of plant extracts, followed by sun exposure-for vitiligo. The same treatment was also used in ancient Egypt. The active ingredients in these plant extracts were isolated in 1947 by Fahmy et al. as 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (MOP). In the same year, these authors and also El Mofty started to treat patients with vitiligo with 8-MOP and sun exposure.

Kromayer, a German dermatologist, designed in 1904 a water cooled mercury vapor UV lamp. He was the first to treat vitiligo with artificial UVB.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

Unlike Psoriasis, the possibilities for treating vitiligo are limited to phototherapy, except for a small number of patients with stable vitiligo, who can be treated with skin autologous pigment grafts.

The first report of the use of ""phototherapy"" in the treatment of skin disorders dates from about 1400 BC among Hindus, as already mentioned. They used ""photochemotherapy""-administration of plant extracts, followed by sun exposure-for vitiligo. The same treatment was also used in ancient Egypt. The active ingredients in these plant extracts were isolated in 1947 by Fahmy et al. as 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (MOP). In the same year, these authors and also El Mofty started to treat patients with vitiligo with 8-MOP and sun exposure.

Kromayer, a German dermatologist, designed in 1904 a water cooled mercury vapor UV lamp. He was the first to treat vitiligo with artificial UVB.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

Unlike Psoriasis, the possibilities for treating vitiligo are limited to phototherapy, except for a small number of patients with stable vitiligo, who can be treated with skin autologous pigment grafts.

The first report of the use of ""phototherapy"" in the treatment of skin disorders dates from about 1400 BC among Hindus, as already mentioned. They used ""photochemotherapy""-administration of plant extracts, followed by sun exposure-for vitiligo. The same treatment was also used in ancient Egypt. The active ingredients in these plant extracts were isolated in 1947 by Fahmy et al. as 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (MOP). In the same year, these authors and also El Mofty started to treat patients with vitiligo with 8-MOP and sun exposure.

Kromayer, a German dermatologist, designed in 1904 a water cooled mercury vapor UV lamp. He was the first to treat vitiligo with artificial UVB.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

UVB Narrowband (/01) therapy

Narrowband (NB)-UVB, or nm UVB (Philips TL 01) has been used in the treatment of vitiligo now for 10 years and was first reported by Westerhof and Nieuweboer-Krobotova. It is now considered as the treatment of choice, because of its advantages over PUVA treatment being: UVB 311 nm is more effective than PUVA and safer, as there are no psoralen-induced side effects and can be used in children and pregnant woman. The NB-UVB can also be achieved with the eximer laser (308 nm). A draw back is that only small areas can be treated at one time and the eximer laser is excluded from home treatment. Narrowband UVB is also recommended in combination with pigmentcel grafting of vitiligo lesions.

Effective treatment ofHyperbilirubin

Approximately 10% of new born babies is affected with Hyperbilirubin. An effective way to treat Neonatal Jaundice is with blue light therapy. An example of phototherapy in the visible region is the treatment of hyperbilirubinemia with blue light (400-500 nm). Unconjugated bilirubin, being a decomposition product of haemoglobin, is not fully soluble in water and plasma. In normal physiological circumstances, this unconjugated bilirubin is bound to albumin and transported to the liver where it is converted by glucuronyltransferase into the water-soluble conjugated form and excreted in the bile. When the albumin binding capacity of the plasma is exceeded (e.g. in icterus neonatorum, in Crigler Najjar syndrome, etc), the unconjugated bilirubin can diffuse into the tissues. Blue light can convert this unconjugated form into a more watersoluble form by a photo-oxidative process and an isomerization process.

The graph illustrates the spectrum of a blue lamp TL/52, just emitting at the maximum effective wavelength of 450 nm. The blue light component in halogen dichroic mirror lamps can also be used (UV and IR filtering is necessary). There has also been research showing the bilirubin content of the plasma being lowered with the help of green light (‘TL’/50). However, the results are still not convincing enough to warrant a change from blue light. The effective use of phototherapy has eliminated the need for exchange transfusion in almost all jaundiced infants. Care must be taken to ensure effective irradiance delivery, to maximize skin exposure and to provide eye protection.

In 1969 Fulton et al. used "black light" UVA tubes for the first time in combination with topical 8-MOP in the treatment of vitiligo. Parrish and Fitzpatrick introduced modern photochemotherapy with 8-MOP, having a peak sensitivity at 330 nm and UVA fluorescent tubes. They used fluorescent tubes emitting in the 320 - 380 nm waveband in the PUVA treatment of vitiligo. Although late effects, e.g. skin carcinogenesis, have rarely been reported in vitiligo, the frequently observed phototoxic responses were considered a severe practical problem.

Effective treatment ofAtopic Dermatitis

The therapy of Atopic Dermatitis includes mainly corticosteroids (CS), antihistamines and immunosuppressors. CS are known to cause a variety of side effects and attempts have been made to reduce or eliminate their use through alternative methods such as phototherapy (UVA/UVB, UVA(1), UVA(2), UVB 311 nm). In the majority of patients, UV irradiation proves favorable.

The active spectrum is mostly in the UV range, between 300 and 400 nm (equipment with TL/10 (=UVA-2), 'TL'/09, filtered HPA). The dosage (quality and quantity of radiation) has to be adjusted to the individual response of the patient and possibly (in case of a reaction of adaptation) be altered in the course of the therapy.

UV radiation can be used for multiple purposes in water and air treatment, but is primarily employed as a disinfection process that inactivates microorganisms without chemicals. For other applications, UV is used for the removal of organic and inorganic chemicals, including chlorine, chloramines, ozone and Total Organic Carbon (TOC) emerging contaminants.

B311 nm UVB therapies has been found to be ideal for following UVA-1 therapy: UVA-1 is used in the initial phase of treatment to manage acute, severe exacerbations of atopic dermatitis and is replaced by nm UVB therapy, which is an effective (and presumably safe) means of maintenance therapy.

Because its presumed safety, it has also been advocated to be used for children.

FDA has cleared Philips Narrowband phototherapy lamps for the treatment of Psoriasis and Vitiligo and has cleared Philips Broadband phototherapy lamps for the treatment of Psoriasis.

Effective treatment ofother skin diseases

Psoriasis, which affects about 2% of Caucasians, and vitiligo, which affects a similar percentage of the dark and light-skinned population, are two examples of skin diseases which can be successfully treated with phototheraphy. But the list of skin diseases which can be treated with photochemotherapy is constantly growing.

Most of these diseases have now been treated with Narrowband UVB, although in a varying degree of effectiveness, which seem to be as good as PUVA. It has also been stated that exposure to ultraviolet “light” causes an exacerbation or produces injurious effects in the following conditions: Xeroderma Pigmentosum, Herpes Simplex, Lupus Erythematosus, several types of Eczema, prematurely senile skin, Porphyria, the use of immunosuppressive medications (after kidney transplants) and Aids.

FDA has cleared Philips Narrowband phototherapy lamps for the treatment of Psoriasis and Vitiligo and has cleared Philips Broadband phototherapy lamps for the treatment of Psoriasis.